Accident Benefits in Ontario After September 1, 2010 Car Accident Benefits, Insurance Company, Insurance Policy

Ontario Accident Benefits After September 1, 2010

The No Fault Insurance Accident Benefits in Ontario changed on September 1, 2010. This article is an update to a previous article we published, Accident Benefits in Ontario. Effective September 1, 2010 an injured person has certain rights regardless of who caused the accident. Please note that the article below deals with the standard no fault insurance protection found in Ontario. There are some optional insurance coverages that can be purchased to increase the various amounts of coverage. Those coverages are not discussed in this article.

If injured in an accident on September 1, 2010 or after, the date of your last insurance renewal period will determine the limits on Benefits available. If your insurance contract existed prior to September 1, 2010 and has not been renewed since that date you will be entitled to very similar coverage in benefits and limits that existed prior to September 1, 2010. The major exception to this is the minor injury guidelines which, for accidents after September 1, 2010, limits the no fault insurance medical benefits to $3,500.00.

If, however, you have purchased a new policy of car insurance or have renewed your policy since September 1, 2010 and are in an accident, there are significantly reduced limits to the accident no fault benefit coverage.

Attached to this article is a chart setting out the comparison of the Accident Benefits available both before and after the September 1, 2010 changes.

Reporting the Accident

If injured in a car accident in Ontario, regardless of the date of the accident or the renewal date of your insurance you should report the accident if there is damage more than $1,000.00 to the vehicles and/or there is any possibility of someone being injured.

If there is any possibility that you, a family member, or an occupant of either car might be injured it is wise to report the accident to your insurer. Often minor aches and pains felt at the scene of the accident develop into much more significant pain and disability in the days after the accident.

Many people report the accident to their insurance broker, often mistaking the broker as the insurer. While it should be common practice for the broker to report the collision to the insurer there is no guarantee that this will happen. Even if the broker does relay the information about the accident to the insurer it is quite possible for the broker to have misinterpreted some of the details. For those reasons you are likely better off reporting the accident to your insurance company directly.

Initial Ontario Accident Benefits Application Process

If you suffer injuries and the accident is reported to your insurer you should expect to receive an Application for Benefits package from your insurance company. The package should include (for accidents after September 1, 2010) a basic Application for Accident Benefits (called an OCF-1), an Employers Confirmation of Income form (called an OCF-2), a Disability Certificate form (called an OCF 3) and a form granting Permission to Disclose Health Information (called an OCF-5).

THERE IS ALMOST ALWAYS ONE MORE FORM IN THE PACKAGE. BE VERY CAREFUL when reviewing your package. The final form the insurance company will send is often a Treatment Confirmation Form (OCF 23). THIS IS THE FORM THAT IS USED UNDER THE MINOR INJURY PRE-APPROVED TREATMENT GUIDELINES AND ESSENTIALLY PIGEONHOLES YOUR CLAIM INTO THE MAXIMUM OF $3500.00 in reimbursement for all medical and rehabilitation expenses you will incur.

It could be very problematic if you get pigeonholed into the pre-approved treatment scheme and your injuries are not supposed to be included. For example, if you suffered from a pre-existing condition that will compound your problems, delay your recovery or increase the types of treatment you require, your injuries should not be in the minor injury category. If you suffer from psychological problems your injuries are not meant to be included in the pre-approved framework.

It is obvious why insurers in Ontario want to get people into the pre-approved framework. If stuck there, the insurance company’s liabilities for treatment and rehab are limited to $3,500.00. If not, the exposure is significantly increased.

When injuries are not within the pre-approved framework the form that is to be submitted to the insurer is a proposed Treatment Plan (OCF 18).

Accident Benefits Available in Ontario

Injured persons can qualify for a number of different Accident Benefits if they meet the legislated requirements. These include Income Replacement Benefits (often referred to as “IRB’s”); medical and rehabilitation benefits (some of which were discussed above); Non-Earner Benefits; Caregiver Benefits; Housekeeping and Home Maintenance Benefits; Attendant Care Benefits; Lost Educational Expenses; Death Benefits; and some Travel Expenses.

Attached as Appendix A to this paper is a chart summarizing the very basic entitlements both pre and post September 1, 2010. It is not intended to be used as legal advice but is included simply to be helpful information to get you started.

This paper is not intended as legal advice as the specifics of the various Accident Benefits entitlements will vary from person to person depending on the nature of the injuries, the pre-existing conditions they had, their employment status and ability or inability to return to work, their family responsibilities, etc. all of which are beyond the scope of this paper.

What should be abundantly clear after reading this paper, however, is the need for a qualified advocate if you have been injured in a car accident in Ontario. A personal injury lawyer or a properly trained and knowledgeable paralegal is entitled to represent you in the Accident Benefits application and approval process. Most will meet with you for an initial review of your circumstances and rights free of charge. If you do not know a personal injury lawyer, let Injury Alliance help. It is free of charge to use and we will get back to you within 24 hours.

APPENDIX A

	For Policies Dated before Sept. 1, 2010	For Policies Dated after Sept. 1, 2010
Income Replacement Benefits ("IRB")	You are entitled to 80% of your net income, to a maximum of $400 per week, if you are substantially unable to perform the essential tasks of your occupation or employment during the first 104 weeks. Thereafter, you can continue to receive these benefits as long as you are continuously disabled and prevented from working at any occupation for which you are reasonably qualified by education, training and experience.	You are entitled to 70% of your gross income with a maximum of $400 per week, if you are substantially unable to perform the essential tasks of your occupation or employment during the first 104 weeks. Thereafter, you can continue to receive these benefits as long as you are continuously disabled and prevented from working at any occupation for which you are reasonably qualified by education, training and experience.
Medical & Rehabilitation Benefits	You are entitled to a maximum of $100,000 for up to 10 years for a non-catastrophic injury; up to $1,000,000 for the rest of the victim's life for catastrophic injuries. For accidents incurred after Sept. 1, 2010, up to $3,500 for minor injuries inclusive of assessment/examination expenses.	For minor injuries, as defined by regulation, up to $3,500 for minor injuries inclusive of assessment / examination expenses. For non-minor injuries, up to $50,000, injuries inclusive of assessment/examination expenses. For catastrophic injuries, up to $1,000,000, inclusive of assessment/examination expenses.
Non-Earner Benefits	Up to $185 a week, if you are not employed and if you suffer a complete inability to carry on a normal life as a result of the injuries from the accident. Non-earner benefits are not payable for the first six months after the accident.	No change.
Caregiver Benefits	Up to $250 a week, if you were the primary unpaid caregiver of a person in need (with whom you were residing), plus $50 for each additional person in need of care.	Eliminated for basic policies.* Available for catastrophic cases only.
Housekeeping & Home Maintenance Benefits	Up to $100 per week for two years for a non-catastrophic injury, and for the remainder of the victim's life in the case of a catastrophic injury.	Eliminated for basic policies.* Available for catastrophic cases only subject to technical interpretations of "incurred expenses" and "ability to perform".
Attendant Care Benefits (for personal care)	Up to $3,000 a month for two years for a non-catastrophic injury ($72,000 maximum), and up to $6,000 per month for the victim's lifetime for a catastrophic injury ($1,000,000 maximum)	Reduction from $72,000 to $36,000 for non-catastrophic cases.* No change for catastrophic cases.
Lost Educational Expenses	Up to a maximum of $15,000 for students.	No change.
Death Benefits	Benefits of $25,000 for the spouse of the victim; $10,000 for each of the victim's dependents; $10,000 to the person upon whom the victim was dependent; up to $6,000 for funeral expenses.	No change.
Travel Expenses	For family members of those living with the accident victim for their visiting costs during treatment or recovery.	No change.